MEDICARE: DR. BABAK HOOSHMAND M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	14717	NV
2	207RI0200X	Infectious Disease Physician	14717	NV
3	207R00000X	Internal Medicine Physician	AS3062508-60	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1023380086
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BABAK HOOSHMAND M.D.

Provider Business Mailing Address
First Line	:	PO BOX 530815
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89053-0815
Country	:	US
Telephone Number	:	725-705-2739
Fax Number	:	702-331-2035

Provider Business Practice Location Address
First Line	:	4472 S EASTERN AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-7825
Country	:	US
Telephone Number	:	725-705-2739
Fax Number	:	702-331-2035

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/06/2012
Last Update Date	:	09/13/2024

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Directions to “ DR. BABAK HOOSHMAND M.D.” Practice Location

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